OBJECTIVES: There is little understanding on the true cost of operating room time in Canada despite the fact that surgical care is paid for by a single payer facing increasing cost constraints. The objective of the review was to analyze how OR costs are currently conceived of in Canadian hospitals. Additionally, a micro costing approach was used to estimate the actual cost using a bottom-up approach. METHODS: A literature search was conducted to determine how Canadian hospitals perceived the value of one hour of operating time. Studies satisfying the defined criteria were compared in terms of methodology and inclusion and exclusion of specific resources in their perception of their institution’s OR expenditure. All costs were adjusted to 2014 Canadian dollars. Additionally, we conducted an independent bottom-up micro-costing analysis of Canadian operating room time. Completion of the literature review prior to micro costing ensured a robust and comprehensive approach was used.  Costs were obtained using peer-reviewed literature and from a large Canadian hospital network.  RESULTS: Specific search and inclusion criteria resulted in the inclusion of 5 studies in our analysis. The cost of OR time ranged greatly from $621.60 to $2288.94 per hour. All studies obtained the cost of OR time using a top-down case-costing approach informed with data from their respective finance departments. Each study was conducted at a different Canadian hospital and OR costs were perceived in strikingly different ways.  Additionally, many of the studies lacked sufficient methodological details providing a challenge when comparing approaches. The bottom-up micro case-costing approach incorporated more than 30 individual costs and resulted in an OR hourly cost of $1200.  CONCLUSIONS: In Canada, there is little consensus between institutions of how to capture the costs of OR time. A bottom-up micro costing approach allowed for a different perspective and a more detailed analysis.